Influence of coronal restorations on the fracture resistance of root canal-treated premolar and molar teeth: A retrospective study

To evaluate the influence of coronal restorations on the fracture resistance of endodontically treated teeth, 676 root canal-filled and restored posterior teeth were evaluated after a mean period of 9.7 (+/-2.8; minimum: 5) years. A total of 86.2% of the endodontically treated and restored teeth survived the mean observation period of 9.7 years without fracture. The overall survival period was 13.6 (+/-0.2) years. All teeth with gold partial crowns survived without fractures (n = 24). Teeth with crowns and adhesively sealed access cavities showed a mean survival period of 15.3 (+/-0.4) years, with crown and bridge restorations 14.0 (+/-0.3), with individual metal posts 13.9 (+/-0.2), with composite fillings 13.4 (+/-0.5), with prefabricated metal posts 12.7 (+/-0.6), with amalgam fillings 11.8 (+/-0.6) and with glass ionomer cements (GIC) 6.6 (+/-0.5) years. Teeth with one or two surfaces restored by amalgam, composite or GIC showed a significantly lower fracture rate than teeth with three and more restored surfaces (P < 0.05). The mean fracture rate of teeth restored with GIC was significantly higher when compared with all other groups (P < 0.001). In general, endodontically treated teeth restored with prosthetic restorations demonstrated a significantly lower mean fracture rate than teeth restored with fillings. Cavities with up to three surfaces may well be successfully restored adhesively with composite filling material.